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What is cuboid syndrome?
Symptoms
Causes
Diagnosis
Treatment
Prevention
FAQs

Cuboid syndrome causes pain on the outside of the foot, around the midfoot, that can affect your ability to stand, walk and exercise comfortably.

What Is Cuboid Syndrome?

You have a bone on the outer border of your foot called the cuboid, that sits in front of the ankle and heel bone. Cuboid syndrome describes the situation where your cuboid bone moves out of alignment with the surrounding bones of the foot and becomes partially dislocated, otherwise known as cuboid subluxation. 

The result is notable pain and discomfort, particularly when the foot comes in contact with the floor and you bear weight on the affected foot.

Symptoms Of Cuboid Syndrome

If you have cuboid syndrome, you’ll likely experience pain and discomfort along the lateral (outer) aspect of the foot, around the cuboid bone. This may be accompanied by:

• Pain on the underside of the foot, which may feel difficult to pinpoint in terms of the exact location of the centre of the pain
  
• Sharp or dull pain sensations, and that may come on slowly or quickly
  
• Being unable to bear weight on the injured foot or needing to limp to get around
  
• Possible swelling, redness or mild bruising in the area of the cuboid
  
• Decreased movement around the affected foot
  
• Pain that may radiate to the outside of the ankle
  

Causes Of Cuboid Syndrome

The most common causes of cuboid syndrome that our Brisbane podiatrists see include:

• Repetitive stress and strain on the foot  
  

To best understand how cuboid syndrome can occur, you have to know that you have a muscle and tendon called the peroneus longus that forms a sling around the cuboid bone, this can place tension on it when this muscle is overused and strained. Thus, when we overload our feet and their muscles, particularly during activities that involve repetitive side-to-side motion or excessive pressure on the lateral foot, cuboid syndrome can develop. This is why dancers, runners, soccer plays and those involved in sports that involve rapid changes in direction can be at increased risk.

• Direct trauma or injury to the foot
  

Having direct impact to the side of the foot, sustaining an ankle sprain or foot fracture, can also lead to cuboid syndrome. 

• Abnormal foot biomechanics
  

Poor foot biomechanics, including having very flat feet or very high arches, or tending to load more through the outside of your feet during gait, may also contribute to the development of this cuboid syndrome.

• Other risk factors
  

Other risk factors for cuboid syndrome include wearing unsupportive or ill-fitting shoes, regularly training and running on uneven surfaces, and going too hard too fast with your training regimen which fails to give your feet sufficient recovery time if you’re working towards an event like a triathlon.

Diagnosing Cuboid Syndrome

Cuboid syndrome can be difficult to diagnose, particularly if your health professional has limited experience with diagnosing or managing this condition. This is because a cuboid subluxation can be difficult to detect even on x-ray, as there are natural variations in what the spaces between the bones around the cuboid look like. This can lead to it being misdiagnosed as a stress fracture or other problem.

Here at The Feet People, our podiatrists take great care when assessing causes of foot pain, carefully listening to your symptoms and your history of how this pain has developed, in order to help attain an accurate diagnosis. As we go through your assessment, we make sure to rule out other causes of pain on the outside border of your foot and are very specific when making medical imaging referrals as to what we are looking for - even noting the best views for helping correctly identify cuboid syndrome on x-ray. 

It is important to note that other injuries can occur simultaneously alongside cuboid syndrome, so we always want to make sure we are getting the complete picture of everything that is happening within your foot, and why this has occurred.

Treatment Options For Cuboid Syndrome

Effectively managing cuboid syndrome involves both relieving your painful symptoms and allowing the injury to heal and repair, as well as putting the right measures in place to keep your feet well supported so we can reduce your risk of sustaining the injury again in the future. 

Home treatment

If you’re experiencing pain on the outside border of your foot at home, we recommend following the PRICE principles until you’re able to get in to see your podiatrist, which involves:

• Protecting the outside border of the foot from external forces and more damage. Often this means reviewing the shoes you wear on a daily basis to ensure it’s not rubbing or causing irritation, particularly if you have broad feet
  
• Resting your feet where possible. This is so the foot can start healing and repair, while reducing the risk of the injury worsening by having added stress applied to the injured site
  
• Icing the foot. Apply ice through a cloth or tea towel (or other protective barrier to avoid direct skin contact) for no more than 20 minutes at a time, 4 times per day, to help with swelling
  
• Compressing the foot by using tape or bandages to strap the area, helping to limit swelling and offering greater protection
  
• Elevating the foot (ideally at heart level) to help reduce inflammation and swelling, which eases painful symptoms
  

Most importantly, you should book an appointment with your podiatrist so you can start your road to an effective, long-term recovery and help prevent your injury and pain from worsening. 

Podiatrist Treatment

After your assessment, your podiatrist will discuss your available treatment options and make recommendations as to the best options given your unique circumstances. We may recommend the use of one or more of: 

• Custom foot orthotics. Orthotics can help support an optimal foot alignment, absorb shock, stabilise the foot and ankle and offload vulnerable and tender areas - all helping in the treatment of cuboid syndrome, as well as helping reduce the risk of future recurrence for those that continue to wear their orthotics when staying active on their feet
  
• Foot mobilisation therapy is a hands-on approach that targets specific joints, including those around the cuboid bone, to alleviate restrictions, improve range of motion, and reduce pain associated with cuboid syndrome. By gently manipulating the affected joints through various mobilisation techniques such as joint glides, traction, and manipulation, foot mobilisation therapy aims to correct biomechanical imbalances, release tension in surrounding soft tissues, and promote optimal joint function.
  
• Assessing the shoes you wear daily to ensure they have enough supportive features to best support your recovery, and aren’t hindering your progress by rubbing against or aggravating the cuboid bone.
  
• Footwear modifications. Our podiatry team is unique in that we are able to make custom modifications to your footwear, if needed, to help them do their best job of supporting your recovery and feet, redistributing excess pressure away from the outer foot border, and optimising your gait.
  
• Activity modifications. We may recommend temporarily modifying certain daily activities or exercise activities to best support healing and repair, so you can get back to doing the things you love.
  
• Physical therapy (stretching and strengthening). Once significant healing and repair has occurred, we may use physical therapy to address any muscle imbalances that may have contributed to your cuboid syndrome.
  
• MLS laser. We are proud to offer the innovative MLS laser to help speed up your repair and recovery, while optimally supporting the relief of your painful symptoms, both at the cuboid and in the general area if other pains or injuries have occurred simultaneously. 
  
• EXO-L anti-sprain brace. If your cuboid injury has occurred alongside an ankle sprain, and you have a history of ankle sprains, we may use interventions to help with this (as it will not be uncommon for you to have some ankle instability). One such approach is using the EXO-L anti-sprain brace.
  

Preventing Cuboid Syndrome

While cuboid syndrome may not be able to be prevented entirely, there are things you can do to reduce your risk of developing it. These include:

• Choosing footwear that provides adequate support and cushioning for your feet, especially if you’re involved in activities or sports that involve repetitive impact or side-to-side motion. Look for shoes with good arch support, cushioned midsoles, and a stable heel counter to help maintain proper foot alignment and reduce strain on the cuboid bone.
  

• Avoiding sudden changes in activity level or intensity, as this can increase the risk of overuse injuries like cuboid syndrome. Instead, gradually increase the duration and intensity of your workouts or physical activities to allow your feet and ankles to adapt and strengthen gradually.
  

• Performing thorough warm-ups to prepare your muscles, tendons, and ligaments for the demands of exercise. Incorporate dynamic stretches and exercises that target the muscles and structures of the foot and ankle to improve flexibility and range of motion, reducing the risk of injury.
  

• Paying close attention to your movement mechanics and technique during sports and activities to minimise excessive stress on the feet and ankles. Practise proper landing and cutting techniques.
  

• Adding exercises specifically targeting the muscles of the feet, ankles and lower legs to improve strength, stability, and proprioception. Simple exercises like toe curls, heel raises, and ankle circles can help strengthen the muscles that support the arches of the feet and promote better foot mechanics, reducing the risk of a range of foot-related issues.
  

Frequently Asked Questions (FAQs)

Can cuboid syndrome recur?

Yes, cuboid syndrome can recur, especially if the underlying biomechanical issues or contributing factors are not adequately addressed - which is why this is an area of key focus for our podiatrists. Those who have experienced cuboid syndrome may be more susceptible to recurrence if they return to activities that place excessive stress on the foot or if they do not follow proper preventive measures, such as wearing their orthotics (if the have been prescribed some), wearing supportive footwear, or engaging in appropriate conditioning and stretching exercises. Additionally, incomplete resolution of symptoms or improper rehabilitation following an initial episode of cuboid syndrome can increase the likelihood of recurrence.

Is cuboid syndrome a serious condition?

While cuboid syndrome is not typically considered life-threatening, it can cause significant pain, discomfort, and functional limitations that interfere with daily activities and quality of life - which make it serious in our eyes - and we’re sure our patients agree. 

Are there any long-term complications associated with cuboid syndrome?

While cuboid syndrome itself typically resolves with appropriate treatment and rehabilitation, there can be potential long-term complications if the condition is not managed effectively or if underlying biomechanical issues persist. Chronic or recurrent cuboid syndrome may lead to ongoing foot pain, instability, and dysfunction, which can impair mobility and diminish overall quality of life. 

Prolonged gait alterations or compensatory movement patterns adopted to avoid pain related to cuboid syndrome may also increase the risk of secondary injuries or conditions affecting the feet, ankles, knees, hips, or lower back. Additionally, untreated cuboid syndrome may contribute to the development of degenerative changes within the foot joints or soft tissues, leading to progressive joint damage and functional impairment over time.